Project Summary/Abstract Chronic Obstructive Pulmonary Disease (COPD) is projected to cost $50 billion in 2020 and is the 3rd leading cause of death in the US. Despite the association of poor adherence with higher mortality in COPD, there is poor adherence among COPD patients. COPD patients have 4 times the prevalence of mild to moderate cognitive impairment (MMCI) than non-COPD patients. Adherence is a vulnerable process and the presence of MMCI is associated with worse adherence. Additionally, 40% of patients with MMCI go unrecognized by providers. Adherence relies on effective patient-provider communication on the medication plan (medication, dose, frequency, and route) and patient understanding of the prescribed plan. The high prevalence of MMCI in COPD patients likely contributes to poor patient-provider communication, subsequent concordance, and ultimately poor adherence. Patient-provider communication as measured by concordance has yet to be studied or targeted for intervention. This study will leverage the ongoing observational Medication Adherence Research in COPD patients study (MARC Study R01- HL128620 PI Eakin) which is looking at the impact of adherence on health outcomes in COPD. Participants are over 40, carry a diagnosis of COPD with consistent spirometry (FEV1/FVC <70% and FEV1<80% predicted), and are on maintenance therapy for COPD. This proposal will capitalize on the MARC population by adding a sub-study of patient-provider concordance on medication plans and the influence of MMCI on such concordance. Concordance analysis will be conducted on pairs of patient and provider reported medication plans. MMCI will be measured by validated assessments including Montreal Cognitive Assessment (MoCA) and the Weschler Memory Scale. Using logistic regression we will examine the impact of MMCI on concordance. A qualitative sub-study evaluating the impact of MMCI on patient-provider communication and concordance on medication plans will be conducted with the addition of semi-structured phone interviews with both patients and providers. Participants with and without MMCI and those concordant and discordant as well as their providers will complete semi structured interviews on the facilitators and barriers to patient-provider concordance and the impact of MMIC on communication and concordance. We expect to find that concordance among patients and providers is poor and the presence of MMCI is a barrier to concordance. The insight into patient and provider perceptions of adherence and communication will uniquely poise this study to inform the development of interventions aimed to improve patient-provider communication and subsequent adherence to medications.